What does drugs requiring detailed coding mean?

What does drugs requiring detailed coding mean?

0636. Drugs requiring detailed coding. For Medicare, revenue code 0636 is used in the hospital outpatient setting. for all drugs and biologicals that are separately payable. The Centers for Medicare & Medicaid Services (CMS) allows separate payment under Medicare for the administration of PROVENGE.

Does rev code 343 require NDC?

For institutional providers: Scheduled for future release in 2009, all claims for outpatient services containing the following pharmacy revenue codes and an unlisted and/or non-specific (CPT or HCPCS) code will require a valid NDC when submitted: 250-259, 262, 263, 331, 332, 335, 343, 344, and 631-637.

When Should revenue Code 636 be used?

Revenue Code 636 is used. It requires HCPCS. Other inpatient drugs continue to be billed without HCPCS codes under pharmacy. Electronic billers must enter the HCPCS code in field 5 of Record Type 60.

What are unclassified biologics?

J3590 – Unclassified biologics. J9999 – Not otherwise classified, antineoplastic drugs. Commonly used when: Drug/biological does not have a specific HCPCS code. Drug/biological is administered by a route other than stated in the code.

What is revenue Code 0919?

0919 in section: 091X – Behavioral Health Treatment/Services-Extension of 090X.

What is the difference between REV code 250 and 636?

A: Many facilities report packaged drugs under revenue code 250 regardless of whether an applicable HCPCS code exists. CMS has recommended that facility providers report all drugs with a HCPCS code under revenue code 636 to better capture actual pharmacy overhead cost through claims data.

What is revenue Code 0636?

0636 – Drugs requiring detailed coding.

How is Entyvio billed?

There are many ways to acquire your patient’s Entyvio prescription. Your preferred method will depend on your practice setting. Buy and bill2: A provider purchases the drug from a wholesaler and bills the health plan for the cost of the drug plus the cost of administration (administration fee).

What is the HCPCS code for packaged drugs?

You may report packaged drugs or drugs that have a status indicator N HCPCS code under revenue code 025X. Also report revenue code 025X for drugs with no HCPCS code. Each facility must assess their billing system’s capabilities for reporting HCPCS codes under revenue code 025X.

What is the Medicare Code for general pharmacy?

Medicare: Use revenue code 0636, drugs requiring detailed coding. Other payers: Use revenue code 0250, general pharmacy (or 0636, if required by a given payer). Related administration procedure Use most appropriate revenue code for cost center where services were performed (eg, 0510, clinic).

What is the code for a chemotherapy drug?

In general, chemotherapy drugs are those in the range of codes J9000-J9999. Certain other highly complex drugs may be billed with chemotherapy administration codes even though they havea J-code outside of the chemotherapy range of codes.

What do you need to know about drug NOC codes?

When using a drug NOC code (J3490, or J3590) list the name of the drug, the amount of the drug that is administered and wasted if applicable; method of administration in the electronic narrative that is equivalent to line 19 of the CMS 1500 form.